How pharmacists can work in primary care

MSAC has greenlit a program embedding non-dispensing pharmacists in Aboriginal health services.

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The collaborative pharmacy-primary care model is gaining traction, despite being dismissed as an option by some parts of the sector.

Earlier this week, the Medical Services Advisory Council released a recommendation to the Health Minister to fund a program which placed non-dispensing pharmacists in Aboriginal Community Controlled Health Organisations (ACCHOs) several days a week.

Under the program, which is called Integrating Pharmacists within Aboriginal Community Controlled Health Services (IPAC), pharmacists spent several days a week in an ACCHO with roles such as medication management, responding to practitioner queries about medicine and liaising with community pharmacy to support patients recently released from hospital.

A trial of the model ran for just over a year between 2018 and 2019, and was originally funded as part of the sixth Community Pharmacy Agreement.

The participating ACCHOs were primarily located in regional and remote areas, and the application to the MSAC notes that pharmacist intervention resulted in clinically significant improvements in glycaemic control for patients with Type 2 Diabetes and control of cardiovascular disease risk factors.

In its decision, the MSAC wrote that it considered the outcomes to be only moderately good, but ultimately felt that the program would not cause harm and could be beneficial.

“MSAC considered that the totality of improvements in biomedical outcomes, prescribing quality, medication adherence, self-rated health status and positive qualitative outcomes reflected an acceptable clinical outcome, compared to usual care, in an under-served population that is known to have typically poorer health outcomes compared to the broader Australian population,” the committee wrote.

“MSAC considered the updated economic and financial analysis indicated the per-patient cost and annual cost were comparable to existing medication review programs and acceptable in the context of providing overall better quality of care that may help improve health inequities for Aboriginal and Torres Strait Islander peoples.”

It also noted that the vast majority of general practitioners working at the ACCHOs had positive feedback about the program.

The push for a team-based model of care is not unprecedented, and its success is not necessarily surprising.

Pharmacists working to an expanded scope in New Zealand follow a collaborative care model, and it’s been supported in the past by the AMA and RACGP in terms of a pharmacist prescribing model.

The Pharmaceutical Society of Australia, the peak body representing employee pharmacists, has long been a supporter of the team-based model and worked with the National Aboriginal Community Controlled Health Organisation to deliver the IPAC trial.

PSA president Dr Fei Sim told The Medical Republic that the project improved the quality of prescribing, medication adherence and patient’s self-rated health status.

“[The] PSA firmly believes that there is scope for greater collaboration between GPs and pharmacists,” she said.

“Meaningful collaboration between health professionals can only result in improved patient health outcomes.”

Despite the pre-existing support for a collaborative model, it has been largely missing from the push for increased scope of practice led by the Pharmacy Guild, which has instead proposed a model where pharmacists prescribe a limited number of medicines in a community pharmacy setting.

The powerful lobby group represents community pharmacy owners and did not respond to TMR’s request for comment before deadline.

The MSAC recommendation is now pending sign-off by Health Minister Mark Butler and endorses a minimum ratio of one full-time pharmacist to 6000 patients and an annual salary of $112,940.